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MB2 Rheumatology and Orthopaedics > Pathology > Flashcards

Pathology Flashcards

1
Q

what is osteoporosis

A

reduced bone density and increased porosity

less than 2.5 SD below peak mean value of young adults of same race and sex

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2
Q

what is osteopenia

A

intermediate osteoporosis where <1-2.5 SD below peak mean value of young adults same sex and race

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3
Q

true/false - bone density loss is physiological?

A

true - osteoblastic activity begins to decrease around 30

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4
Q

why is osteoporosis more common in females

A

post menopause has less protective oestrogen so there is increased osteoclastic activity

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5
Q

causes of postmenopause primary osteoporosis and types of fracture

A 
early menopause 
smoking 
lack exercise 
poor diet 
colles fracture and vertebral insufficiency
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6
Q

causes of osteoporosis of old age and types of fracture

A

reduced vitamin D
chronic disease
inactivity
femoral neck fracture and vertebral fracture

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7
Q

causes of secondary osteoporosis

A 
steroid use 
chronic disease
alcohol abuse 
malnutrition 
hyperthyroidism/hyperparathyroidism
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8
Q

what is the purpose of bisphosphonates

A

reduce osteoclastic absorption

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9
Q

what is zoledronic acid

A

IV annual bisphosphonate

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10
Q

action of desunomab?

A

reduces osteoclastic resorption

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11
Q

action of strontium in osteoporosis

A

increases osteoblast replication and reduces resorption

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12
Q

true/false - HRT is the best first line management for post menopause osteoporosis

A

false - bisphosphonates are as HRT has raised risk of breast and endometrial cancer as well as DVT

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13
Q

what is osteomalacia?

A

qualitative defect of bone leading to abnormal softening due to deficient mineralisation of calcium and phosphorus

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14
Q

causes of osteomalacia

A 
inadequate sunlight exposure 
malabsorption 
malnutrition 
vitamin D resistance 
chronic kidney disease
long term anticonvulsant use
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15
Q

symptoms of hypocalcaemia

A 
parasthesiae 
muscle cramp
irritable 
fatigue 
seizure 
brittle nails
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16
Q

what would you see on biochemistry with osteomalacia

A

low serum Ca and phos

high alk phos

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17
Q

what would you see on x rays of osteomalacia

A

pseudofracture of pubic rami, prox femora, ulna, ribs

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18
Q

causes of primary hyperparathyroidism

A

benign adenoma
malignant neoplasia
hyperplasia

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19
Q

symptoms of hyperparathyroidism

A 
stones 
bones 
groans 
moans 
thrones 
psychiatric overtones
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20
Q

what is secondary hyperparathyroidism caused by

A

hypocalcaemia - causes overproduction of PTH

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21
Q

most common benign bone tumour/

A

osteochondroma

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22
Q

how does osteochondroma appear?

A

bony outgrowth with cartilagenous cap

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23
Q

true/false - there is a 2% chance of malignant transformation with osteochondroma

A

false - it is <1%

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24
Q

what is enchondroma and how does it appear

A

intramedullary and metaphyseal cartilagenous tumour by failed enchondral ossification
lucent and partly sclerotic

25
Q

what bones is enchondroma more common in

A

femur, humerous, tibia, small bones hands and feet

26
Q

what is an aneurismal bone cyst and what bones is it more common in

A

lots of chambers filled with blood/serum due to arterovenous malformation
long bones, flat bones, vertebra

27
Q

what is a simple bone cyst and where may it be found

A

cavity filled cyst in bone proximal humerous or femur in metaphysis

28
Q

true/false - simple bone cysts and aneurismal bone cysts both cause pathological fracture

A

true

29
Q

what is a giant cell tumour and in what bones may it be found

A

benign tumour involving epiphysis extending to subchondral bone
knee and distal radius but also pelvis, spine and long bones

30
Q

true/false - giant cell tumour can metastasise to lung

A

true - but it is still benign

31
Q

what is fibrous dysplasia

A

genetic mutation in adolescents where there is lesions of fibrous tissue and immature bone

32
Q

extensive fibrous dysplasia of the femur may cause ___

A

shepherds crook deformity

33
Q

describe how an osteoid osteoma appears

A

immature bone surrounded by sclerotic halo

34
Q

in what bones is an osteoid osteoma more common

A

proximal femur, diaphysis long bones and vertebrae

35
Q

how would a malignant lesion appear on x ray

A

cortical destruction
periosteal reaction
new bone formation
extension into soft tissue

36
Q

what bones does osteosarcoma affect and how does it spread

A

knee, proximal femur, proximal humerous, pelvis

haematogenous

37
Q

true/false - osteosarcoma is responsive to adjuvant therapy

A

true

38
Q

what age group does chondrosarcoma affect, what bones does it affect, what is it responsive to, fast or slow to metastasise

A

older age of around 45
pelvis or proximal femur
not responsive to radiotherapy or adjuvant
slow to metastasise

39
Q

fibrosarcoma is more commmon in who?

A

fibrous dysplasia, pagets, post radiation

40
Q

what is ewings sarcoma, what age, what does it respond to

A

malignant tumour of primitive cells in marrow
10-20
chemo and radiotherapy

41
Q

surgery for primary malignant bone tumours involves resection with what cm margin

A

3-4 cm

42
Q

metastatic breast cancer is blastic/lytic and survival is?

A

blastic or lytic

24 months

43
Q

metastatic lung cancer is blastic/lytic and survival is

A

lytic

6 months

44
Q

metastatic prostate cancer is blastic/lytic and survival is

A

sclerotic (blastic)

45% survive 1 year

45
Q

metastatic renal cancer is blastic/lytic and survival is

A

lytic vascular blow out that can bleed
if only 1 with a resectable primary tumour then may be cured
if not 12-18 months

46
Q

features of benign soft tissue tumour

A 
small size 
well defined 
translucent 
regression in size 
cystic 
fluid filled 
soft lesion
47
Q

features of malignant soft tissue neoplasm

A 
quick growth 
systemic symptoms 
solid lesion 
large lesions 
ill defined 
irregular surface 
lymphadenopathy
48
Q

what is a ganglion cyst

A

herniation of weak portion of synovial joint capsule or tendon sheath

49
Q

what are the causes of a ganglion cyst and how may it appear

A

developmental or due to underlying joint damage/arthritis

transilluminate, firm, well defined

50
Q

what is a bursa

A

small fluid filled sac lined by synovium around joint to prevent friction

51
Q

what is bursitis

A

inflammation of bursa after repeated pressure

52
Q

true/false - abscesses resolve with antibiotics

A

false - you need to drain them

53
Q

what is avascular necrosis and what bones does it affect

A

ischaemic necrosis of bone

femoral head/condyles, proximal humerous, talar neck, scaphoid

54
Q

risk factors for avascular necrosis

A 
idiopathic 
alcohol use 
steroid use 
primary hyperlipidaemia 
thrombophilia 
sickle cell disease 
antiphospholipid syndrome 
decompression sickness
55
Q

what follows avascular necrosis

A

secondary OA

56
Q

primary cancer risk factors

A

idiopathic
previous radiotherapy
pagets, fibrous dysplasia, multiple echondromas
li fraumeni, familial retinoblastoma

57
Q

red flags for primary bone malignancy

A 
pain not with movement 
worse at night 
swelling/erythema 
palpable mass
fracture 
systemic symptoms 
age
58
Q

when would you see a tumour on x ray

A

when >50% cortical bone destroyed so get a bone scan, CT, MRI if suspicious

59
Q

common sites of secondary bone cancer?

A

BLT with kosher pickle

Breast, lung, thyroid, kidney, prostate

MB2 Rheumatology and Orthopaedics (22 decks)

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